Transcription
In 2020, we presented a case report stating that conventional angiography can show stent apposition. Here are the case's clinical features. At this congress, a patient named Antonio Colombo with complex PCI had a short chronic total occlusion in the LAD. The diagonal diameter was 2 mm; a side branch was present. The lesion is shown here. We crossed it with a hydrophilic guidewire after a 10-minute attempt. Then, a 2 mm balloon catheter was passed, although with some difficulty. However, it could not open the lesion. Therefore, we used a 3 mm NC balloon and then a 3.23 DES. When we deployed the stent, we gave a small amount of contrast in the proximal segment because the diameter difference between the proximal and distal segments was small. We checked the side branch passage by giving contrast while the stent balloon was open. Here, the contrast passed through the stent balloon; thus, the stent puff sign was positive. Later, when we tested this with a post-dilation balloon, we saw that there was no passage; thus, the post-puff sign was negative. This shows that the stent position was good in the proximal main vessel. This is our final angiogram.
From this, we concluded that we can show stent apposition using the stent puff sign by giving a small amount of contrast, especially when the diameter difference between the proximal and distal segments is small. We can use this before and after side branch intervention. Of course, if the diameter difference is large, we need to perform post-dilation. This is the image after lesion preparation; the diameter difference was small. We first tried the stent puff; when the stent puff was positive, you see the passage into the diagonal side branch when we gave contrast. At 20 atmospheres, the stent balloon was now in a post-dilation balloon. In the second phase, we saw that the post-puff sign was negative, showing that the stent was perfectly apposed. Amar and colleagues published this in 2023 in EuroIntervention; however, it was presented at this congress, and the presentations were still open. They have now been closed due to our notification, but the live broadcast video may still be visible. This is our final angiogram; it turned out very well.